Prolotherapy for Achilles Tendinopathy

Prolotherapy (proliferative therapy) is a nonsurgical regenerative injection technique that introduces small amounts of hyperosmolar dextrose to the site of painful or degenerated tendons or their insertions. Under ultrasound guidance, a 25-gauge needle is used to fenestrate and inject hyperosmolar dextrose into the injured area of the Achilles tendon. This is found to induce the proliferation of new cells, allowing the regeneration of healthy tissue. The purpose of this study was to evaluate the treatment response to prolotherapy in Achilles tendinitis.

We reviewed 132 participants with nontraumatic Achilles tendinopathy. Data were collected retrospectively from electronic health records from January 1, 2014, to December 31, 2017. These participants have Achilles tendinopathy from daily activity. We excluded any traumatic cause, history of Achilles tendon rupture, and tendon pathology. Participants were followed for 12 months; those lost to follow-up were excluded. The duration of pathology, number of prolotherapy sessions, and outcome data were recorded. Musculoskeletal radiologists performed the prolotherapy. We received an exemption from the institutional review board of Boston Medical Center for this study.

One hundred thirty-two participants (45 men and 87 women) met the study's criteria, with a mean age of 55 years (range, 21-80 years). Overall, within 12 months, 98 participants (74.2%) experienced symptom resolution. Seventy-one participants (53.8%) experienced symptom improvement with a single treatment. Thirty-four participants (25.8%) still had symptoms after 12 months.

This study demonstrated that prolotherapy yielded excellent results for Achilles tendinitis, particularly for participants without skeletal deformities. No adverse events were reported during the 12-month study. A prospective, comparative, and randomized controlled study with long-term follow-up is needed to determine the efficacy of prolotherapy.